Title : Effect of Awareness Programme on Knowledge regarding Respectful Maternity Care (RMC)

 Effect of Awareness Programme on Knowledge regarding Respectful Maternity Care (RMC) 



Effect of Awareness Programme on Knowledge regarding Respectful Maternity Care (RMC) among Antenatal Women in a Selected Hospital of West Bengal


A quantitative study was undertaken to evaluate the effect of awareness programme on knowledge regarding respectful maternity care (RMC) among antenatal women in a selected hospital of West Bengal. In this study, quasi experimental research approach along with non-randomised control group design was adopted. Non-probability purposive sampling technique was used to select 60 antenatal women (30 each in experimental and control group) admitted in the antenatal ward, Medical College & Hospital (MCH) Kolkata during 1 Oct to 30 Nov 2013. Data was collected by a valid and reliable (r=0.86) structured interview schedule. Pre-test and post-test of control group was completed first. Then pre-test followed by awareness programme was given to experi-mental group and post-test was taken on Day 8. Results revealed that the mean post-test knowl-edge score (32.53) of experimental group was significantly higher [t (df29)=43.84**, p<0.05, p<0.01] than mean pre-test knowledge score (18.50). There was significant difference [t (df 58) = 9.99**, p<0.05, p<0.01] between the mean post-test knowledge scores of experimental and control groups, indicating the effectiveness of awareness programme. The study also found significant associa-tion between knowledge score of women with educational qualification (2 df 1 = 6.54, p<0.05) and socio-economic status (2 df1 = 6.04, p<0.05). The study has implications in different nursing fields. The study recommends for a qualitative and survey on adherence to RMC.

Pregnancy and childbirth are very important events in the lives of women and families and represent a time of intense vulnerability.

Women’s experience with maternity caregivers has the power to give strength and comfort or to cause lasting damage and emotional trauma (Kruk et al, 2009). Very often mother seeking maternity care becomes the victim of disrespect and abuse in care settings (Humiliation reported in Kenya, 2012). Diana Bowser and Kathleen Hill released a landscape analy-sis commissioned by the USAID, ‘Translating Research into Action (TRAction) Project’. Data collected from maternity care systems of over 18 countries, including the wealthiest to the poorest nations, indicated that disrespect and abuse of women seeking maternity care were becoming urgent problem world-wide (Kruk et al, 2009; Bowser & Hill, 2010).

A previous negative experience not only causes under-utilisation of skilled birth care but it can cause a lasting emotional trauma to a woman. So, the way of giving care definitely is an important point to reach the optimum goal of maternity care. That’s why ‘Humanisation of Childbirth movement’, began in Brazil in the 1970s. This focused on providing a birth experience that is fulfilling and empowering to women and their providers, and promotes the active participation and decision making of women. International Initiative on ‘Maternal Mortality and Human Rights’ (IIMMHR) also has given importance and recognised the integration of human right principles as significant to eliminate unnecessary maternal death and injury.

Respectful maternity care (RMC) means caring of mother during maternity, with maintaining women’s rights, social justice, social norms and giving importance to women’s decision making.


This study was undertaken with the following objectives:

  1. To develop and validate awareness programme on RMC.
  2. To assess knowledge level of antenatal women of control group regarding RMC without any inter-vention.
  3. To assess knowledge level of antenatal women of experimental group regarding RMC before and after administration of awareness programme.
  4. To find out the effect of awareness programme regarding RMC in terms of change in knowledge score of antenatal women.
  5. To find out the association between pre-test knowledge score and selected demographic variables of antenatal women in experimental group.


H1 Mean post-test knowledge scores of antenatal women of experimental group after receiving awareness programme is significantly higher than mean pre-test knowledge scores at 0.05 level of significance.

H2 Mean post-test knowledge scores of antenatal women of experimental group after receiving awareness programme is significantly higher than mean post-test knowledge scores of antenatal women of control group at 0.05 level of significance

Literature Review

Poor quality of care and previous negative experi-ences with health facilities and little role in making decisions restrict women for institutional delivery in Ethiopia (S Shiferaw, M Spigt, M Godefrooij, Y Melkamu, M Tekie 2013). Memories of disrespect and abuse may stay with the women life long and strongly affect women’s feelings about their babies, about themselves as mothers (Stoffregen, 2010); this may cause profound consequences on the reproductive lives of the women, affecting sexuality, desire to have child and expectation of mode of delivery and it can influence the lives of women during pregnancy and childbirth (A Mette, H Kjaergaad, J Midtgaard, 2013).


In this study, a quasi-experimental research ap-proach with quasi-experimental non-randomised con-trol group design was adopted.

Symbolic presentation of the design-


Experimental Group (E)

Day-1 x  Day-8

Control Group (C)

O3 ---  O4




O1  - Pre-test knowledge of experimental group.

X - Introduction of awareness programme.

O2 - Post-test knowledge of experimental group.

O3 - Pre-test knowledge of control group.

O4 - Post-test knowledge of control group without introduction of awareness programme.

--- -  No intervention.

Pilot study was conducted at Lady Duffrin Victoria Hospital, a part of MCH and final study was conducted at antenatal ward, Medical College and Hospital, Kolkata. Population for this study was the all antenatal women of West Bengal. Samples were antenatal women admitted in the antenatal ward of that hospital and who had fulfilled sampling criteria. Non-probability purposive sampling technique was adopted to select sample. Total 35 and 37 samples were selected for control group and experimental group respectively but due to sample mortality (DORB/ discharge/ onset of labour pain) final sample size was 30 in each group.

Inclusion Criteria: Newly admitted antenatal women (admitted within 8 am – 4 pm) during the data collection period irrespective of gestational age; antenatal women who were supposed to stay in hospital for at least 7 days, who understood Bengali/English, and were willing to participate in the study.

Exclusion Criteria: Antenatal women who were very sick and those who were mentally challenged. 

Data Collection Tools and Techniques

Structured Interview schedule included demographic variables like age, inhabitation, educational qualifications, occupation, socio-economic status and gravida. Structured Knowledge Questionnaire elicited knowledge of participants regarding RMC.

Validity and reliability of the tool: The tool and aware-ness programme were validated by 9 experts of different fields of nursing including an advocate to verify the content and legal aspect. Reliability was found 0.86 by Cronbach’s alpha method.

Ethical consideration: Ethical permission was received from MCH, Kolkata. Informed written consent was taken from the subject and confidentiality was maintained.

Final data collection: Pre-test and post-test of control group was completed first with a 7 days gap. After discharge of last participant in control group selection of participants in experimental group was started to avoid contamination of sample. Pre-test followed by awareness programme in same day was given to experimental group and post-test was taken on day-8. Data was collected from 1 October to 30 November, 2013.


Awareness programme on RMC: There was 98 percent agreement in majority of areas of content and power point slide and pamphlet. Awareness programme was modified as per suggestions given by experts.

Table 1 shows that half of women (50%) in experimental and majority (60%) control group were in the age group of 19-25 years, majority of women belonged to urban community and APL socio-economic status in both the groups; all women were home makers.

Majority in experimental group (50%) and control group (46.67%) had educational qualification of 5th to 10th standard and above 10th standard respectively. In experimental and control group majority (56.67%) were primi-gravida and multi-gravida respectively.

Knowledge score of antenatal women of control and experimental group and effectiveness of awareness programme


Data presented in Table 2 shows that:

There was no significant mean difference [t (58) 0.28; p>0.05] between pre-test knowledge score of control and experimental group which con-firmed homogeneity of the groups.

The mean post-test knowledge score (19.13) of control group is non significantly higher [t (29) 

0.85; p> 0.05] than the mean pre-test knowledge score (18.9) without any intervention.  The mean post-test knowledge score (32.53) of experimental group was significantly higher [t= 43.84**; p<0.05, p<0.01] than the mean pre-test knowledge score (18.5) after administering awareness programme which showed effective-ness of awareness programme.

 The mean post-test knowledge score (32.53) of experimental group was significantly higher [t (58) = 9.99**; p<0.05, p<0.01] than the mean post-test knowledge score (19.13) of antenatal women of con-trol group also showed the effectiveness of aware-ness programme to increase knowledge on RMC.

Association of knowledge score with selected demo-graphic variables  Significant association was noticed between knowl-edge score of women with educational qualifica-tion (2 df1 = 6.54, p<0.05) and socio-economic status (2 df1 = 6.04, p<0.05) while no statistical association was found between knowledge score with age, inhabitant and gravida (Table 3).




In the present study, lack of knowledge (below 50% mean knowledge score) during pre-test in both control and experimental group were in the areas of respectful maternity care with meaning (46.64%, 44.55% respectively); right to have information and informed consent and refusal (45.40%, 37.40% respectively); right for dignity and respect (43.33%, 33.33% respectively); right for liberty, autonomy, self-determination (34.33%, 39% respectively); prevention of disrespect and abuse (46.67%, 43.33% respectively) (Fig 1).

In the pre-test there was inadequate knowledge (adequate knowledge 75% knowledge score) in all the areas of RMC among control and experimental group and beside this maximum number of antenatal women in experimental group (96.67%) and control group (90%) had inadequate knowledge regarding RMC. That means a large number of antenatal women are not aware about their rights.

These findings are supported by study conducted by Josephine Changole, Chiwoza Bandawe, Bonus Makanani, Kondwani Nkanaunena, Frank Taulo, Eddie Malunga and others where 51.0 percent had ever heard of patient’s rights. 57.4 percent knew that it is the right of the patient to have considerate and respectful care. Other rights mentioned by the respondents were medical information (26%), making decision about the plan of care (23%). Therefore, it is evident that, women have lack of awareness regarding their childbearing rights and concept of RMC.





This awareness programme can be utilised as a tool for generating awareness among women in general, childbearing women, families and communities including maternity care providers, students on RMC. All maternity units can use the pamphlet on RMC and that can be distributed to mothers approaching stage of maternity care. Posters on RMC should be present in all maternity care settings and can be helpful to prevent the violation of those rights.

It can serve the basic knowledge for quality maternity care and quality improvement by prevention of unwanted disrespect and abuse of childbearing women. This is also helpful to construct the outline of rules, regulations, policy formulation for ensuring rights of childbearing women.



  • A similar study can be done on a large sample in different settings or among different population (e.g., post-natal women, women, primi-gravida mother etc.).
  • Studies on (a) assessing the types and the prevalence of disrespect and abuse of labouring mothers and associated factors and (b) quality of maternity care perceived by childbearing women attending selected hospital can be conducted.
  • Qualitative study on perception of maternity care by the childbearing women in childbirth settings can be undertaken.
  • Survey can be conducted to assess the adherence to RMC.



The study concluded that although the knowledge of antenatal women regarding RMC is not adequate but some knowledge is present among them and the awareness programme on RMC is found effective enough to enhance the knowledge of the antenatal women.


  • Respectful Maternity Care: The universal rights of child bearing women. 2011 [6]. Available at: http://www.healthpolicy project. com/pubs/46_FinalRespectful CareCharter.pdfý. Accessed April 20, 2013.
  • Respectful Maternity Care. 2013 [1]. Available at: http://www. maternalhealthtaskforce.org/respectful-care. Accessed April 16, 2013.
  • Stoffregen M. Human Rights-Based Approaches to Maternal Mor-tality Reduction Efforts. 2010;(32). Available at: http :// righttomaternalhealth.org/.../IIMMHR%20 Field%20project %20booklet.p...ý Accessed May 28, 2013
  • One in five women reports disrespectful or humiliating treatment during childbirth at Kenya hospitals and clinics. 2012 (1). Avail-able at: http://www.popcouncil.org/mediacenter/newsreleases/ 2012_HeshimaSurvey.asp. Accessed May 20, 2013
  • Bowser D, Hill K. Exploring evidence for disrespect and abuse in facility-based childbirth. 2010 [57]. Available at: http:/ www.mhtf.org/wp.../Respectful_Care_at_Birth_9-20-101_ Final. pdfý. Accessed May 22, 2013.
  • Shiferaw S, Spigt M, Godefrooij M, Melkamu Y, Tekie M. Why do women prefer home births in Ethiopia? BMC Pregnancy & Child-birth [serial online] 2013 January;13 [5]. Available from: http:// www.biomedcentral.com/1471-2393/13/5. Accessed May 23, 2013

Author: Das Debyani1, Mani Smritikana2


The authors are: 1. Senior Lecturer, University College of Nursing & JNM Hospital, Kalyani, Kolkata (WB), and 2. Principal, College of Nursing, Medical College & Hospital, Kolkata (WB).


Source: TNAI Journal

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